14th Congress of the Middle East Society for Organ Transplantation and the 5th Middle East Transplant GamesKidney transplantationLong-Term Study of Steroid Avoidance in Renal Transplant Patients: AÂ Single-Center Experience

- Among low-immunological-risk recipients of live-donor renal transplants, steroid avoidance was feasible and safe.
- Steroid avoidance was associated with less morbidity using basiliximab induction, then tacrolimus, and mycophenolic acid as maintenance immunosuppression.
- Steroid avoidance in long-term experience was associated with a lower total cost despite comparable immunosuppression cost, which was attributed to the lower cost of associated morbidities such as hypertension and diabetes mellitus.

ObjectivesSteroids have played a major role in renal transplantation for more than 4 decades. However, chronic use of steroids is associated with many comorbidities. This study aimed to assess the costs and benefits of a steroid-free immunosuppression regimen in a prospective randomized controlled study of living-donor renal transplantation, which was lacking in the literature.Materials and MethodsIn our study, 428 patients were enrolled to receive tacrolimus (Tac), mycophenolic acid (MPA), basiliximab (Simulect, Novartis, Basel, Switzerland) induction and steroids only for 3 days (214 patients, study group) and steroid maintenance (214 patients, control group). Median follow-up was 66 ± 41 months.ResultsWe found that both groups showed comparable graft and patient survival, rejection episodes, and graft function. Posttransplantation hypertension was detected in 40% of the steroid-free group and 80% of the steroid maintenance group (P = .05), whereas posttransplantation diabetes mellitus was detected in 5% and 15% of these 2 groups, respectively (P = .3).ConclusionsAmong low-immunological-risk recipients of living-donor renal transplants, steroid avoidance was feasible, safe, and had less morbidity outcome using Simulect induction, then Tac and MPA as maintenance immunosuppression. Steroid avoidance was associated with a lower total cost despite comparable immunosuppression cost, which was attributed to the lower cost of associated morbidities.